Table 2 Detailed descriptions of included quantitative studies, organized by primary PCC objective
Author and title | Type of intervention | Intervention details | Outcomes (Person-centered care (PCC), labor and delivery, perinatal, mental health) | |
|---|---|---|---|---|
Person-Centered Objective: Autonomy | ||||
1 | Benjamin, 2001 | Autonomy | Intervention: Continuity midwifery model consisting of a pair of midwives providing care to one woman through prenatal, birth, and postpartum. Where: United Kingdom Population: Pregnant Women Study design: Prospective, non-randomized clinical trial Sample size: 611 | PCC: attended in birth by a known midwife (OR 39.65, p < 0.001). Labor and delivery: higher home birth (OR 15.38, p < 0.001), lower epidural (OR 0.56, p = 0.002), higher upright birth (OR 9.64, p < 0.001), higher intact perineum (1.57, p = 0.027), higher physiologic third stage (OR 38.69, p < 0.001), lower induction of labor (OR 0.66, p = 0.042). Perinatal: No significant difference in Apgar scores, Admission to Neonatal Unit (NNU) and death. |
2. | Brown, 2015 | Autonomy | Systematic Review of interventions that gave women their own case notes to carry in pregnancy, 4 trials included. Sample Size: 1176 | PCC: Women felt more in control (RR 1.56, 95% CI 1.18 to 2.06), no difference in satisfaction. Labor and delivery: More women had operative deliveries (RR 1.83, 95% CI 1.08 to 3.12), and caesarean sections (RR 1.51, 95% CI 1.10 to 2.08), no difference in analgesics. Perinatal: No difference in stillbirth. Mental Health: No difference in maternal depression. |
3. | De Koninck, 2001 | Autonomy | Intervention: Continuity midwifery model implemented into birth centers that employed 3–6 midwives to provide care to one woman through prenatal, birth, and postpartum. Where: Canada Population: Pregnant women Study design: Intervention and matched controls Sample size: 2000 | PCC: Longer visits (78 vs. 33 min, p < 0.001), had the opportunity to ask questions “very often” (84.6% vs. 64.1%, p < 0.001), rated their care as “very personalized” (87.9% vs. 33% p < 0.001). Delivered by a continuity provider (70.5% vs. 38.8%), able to choose labor position (84% vs. 25%, p < 0.001). Feeling of control over delivery (mean 4.33 vs. 3.95, p p < 0.001). |
4. | Fraser, 1997 | Autonomy | Intervention: Prenatal education and support given by a research nurse coordinator. Where: Canada Population: Women with a prior cesarean Study design: Randomized controlled trail Sample size: 21 | PCC: No difference in perception of control on the Birth Experience Rating Scale. Labor and delivery: No difference in vaginal delivery. Perinatal: No differences in perinatal mortality or maternal morbidity. |
5. | Gerancher, 2000 | Autonomy | Intervention: Verbal consent process for epidural anesthesia with a written consent form, reviewed and signed by both the patient and the investigator, patient received copy of the written consent form for their reference. Where: United States Population: Women in labor Study design: Randomized to intervention Sample size: 82 | PCC: Better recall scores of information in the written and verbal consent group (p < 0.001). |
6. | Gu, 2013 | Autonomy | Intervention: A new midwife antenatal clinic (not a continuity model because the midwives did not provide intrapartum care). Where: China Population: Primiparous pregnant women Study design: Randomized controlled trial Sample size: 110 | PCC: More satisfaction upon admission (p < 0.001) and more satisfaction with the perinatal care experiences (p < 0.001). Labor and Delivery: Higher vaginal delivery (66% vs. 43%, 95% CI 3.69–41.60). No significant differences in mean maternal blood loss. Perinatal: No significant differences in Apgar scores. Mental Health: No difference in anxiety. |
7. | Horey, 2004 | Autonomy | Systematic review of interventions to support women’s decision-making about mode of birth after cesarean. Three Randomized controlled trials were included. Sample size: 2270 | PCC: Less decision conflict about preferred mode of birth (SMD −0.25; 95% CI -0.47 to − 0.02); no increase in knowledge with decision support; no difference in satisfaction. Labor and delivery: No significant difference in vaginal birth, elective/scheduled caesarean and attempted vaginal delivery. Perinatal: no significant differences in adverse outcomes. |
8. | Kuo, 2010 | Autonomy | Intervention: A birth plan that consisted of a detailed conversation with a nurse about common procedures encountered on labor and delivery, women then signed an individualized birth plan with their obstetrician. Where: Taiwan Population: Pregnant women, no complications Study design: A randomized, single-blind controlled trial Sample size: 296 | PCC: More positive childbirth experiences (t = 2.48, p = 0.01), higher degree of childbirth control (t = 9.60, p < 0.001), no difference in prenatal childbirth expectations; higher postnatal fulfillment of childbirth expectations after delivery (t = 2.63, p = 0.01), especially mastery and participation subscale (t = 3.74, p = 0.001). No difference in care-giving environment, spousal support, labor pain expectations, or medical support. |
9. | Lundgren, 2003 | Autonomy | Intervention: Antepartum questionnaire and a birth plan formulation. Where: Sweden Population: Women not planning elective caesarean section Study Design: All women in a set period of time were invited to participate, compared to women in same facilities in period directly before. Sample size: 271 | PCC: Lower scores for the relationship to the first midwife they met during delivery (p < 0.05, domains: listening and paying attention to needs and desires, support, guiding, and respect). No difference with time spent, competence, trust, or support. Labor and Delivery: No difference in fear of childbirth, pain during childbirth, sense of control, concerns for the child, and the total experience. |
10. | Macfarlane, 2014 | Autonomy | Intervention: A new freestanding birth center. Where: United Kingdom Population: Women living in a low socio-economic Inner- city area Study design: Pre/Post evaluation Sample size: 620 | PCC: More choice for birthing position (83.8% vs. 51.6%); told to follow their own urge to push (52.2% vs. 16.9%). Women reported 29.7% higher satisfaction (good and very good care) overall 95%CI, −38.5, −18.7 and reported staff were always kind and understanding 38.2 95%CI, −47.7, −27.4. More women were cared for my a midwife they had already met 37.9%, 95%CI, − 49.5, −25.8, had one and one care all the time 36.9%, 95%CI, − 47.9, − 23.6. More women used a birth plan 19.5 95%CI, − 33.0, − 4.8. Women reported greater privacy (always) 19%, 95%CI, − 28.9, − 8.1, respect and dignity (yes, definitely) 34.8% -44.6, − 23.8, cleanliness (Yes, very clean) 56.2%, 95%CI, − 65.6, − 44.0. Labor and Delivery: fewer inductions (10% vs. 20.2), fewer AROM (13.3% vs 26.7%), more ability to move in labor (92% vs. 70.5%), more spontaneous vaginal birth (73.8% vs. 62.2%), fewer episiotomy (11.1% vs. 17.0%). No significant differences in oxytocin augmentation or continuous electronic fetal monitoring (EFM). |
11. | Martin, 2014 | Autonomy | Intervention: A specialty clinic for women who experienced a prior caesarean, designed to create a supportive environment in order to address childbirth fear, confidence, and knowledge and intention to pursue a Vaginal Birth After Cesarean (VBAC) in the current pregnancy. Where: Australia Population: Women with a prior caesarean Study Design: Comparative descriptive study Sample size: 92 | PCC: More knowledge of behavioral techniques to cope with labor and birth (81.8% vs 50%); no significant change over time within or between groups in childbirth fear; increase in childbirth self-efficacy at 36 weeks GA (p = 0.01). Higher preference for VBAC at 36 weeks GA (80% vs. 56.3%). Labor and delivery: No difference in actual VBAC rates. |
12. | Martinez, 1992 | Autonomy | Intervention: Early Intrapartal Childbirth Preparation included labor information and practice strategies, in a twenty-minute session during the latent phase of labor. Where: United States Population: Women in labor Study Design: Random assignment to study group Sample size: 89 | Labor and delivery: Shorter Stage 1 of labor; higher holism associated with decreased length of labor. Mental Health: No differences on emotional response to labor. Higher coherence associated with less negative emotional responses for all subjects. |
13. | McCourt, 1988 | Autonomy | Intervention: One-to-one midwifery care practice where one midwife plans and provides the majority of antenatal, intrapartum, and postpartum care. Where: United Kingdom Population: Pregnant women Study Design: Prospective, all women in intervention facilities compared to control facilities in different postal area Sample size: 1400 | PCC: More likely to have named midwife as primary caregiver (97% vs 74%), to say they knew their primary provider “very well” (16% vs 4%), preferred to see their primary caregiver (86% vs 50%), to state they were “very well prepared” for birth (18% vs 12%), to feel confident about labor (51% vs 39%), to rate the birth as “hard work but wonderful” (51% vs 39%), have continuous support from midwife (90% vs 53%), and more likely to be “very satisfied” (79% vs 71%). No differences in listening or explanations. Labor and Delivery: fewer augmentations of labor (29% vs. 37%). |
14. | Mehdizade, 2005 | Autonomy | Intervention: Birth preparation classes including pedagogic material, counseling sessions, and neuromuscular exercises. Where: Iran Population: Primigravid women under 35 Study Design: Random assignment to intervention and control groups. Sample size: 200 | Labor and delivery: Lower rate of caesarean section (p = 0.044), shorter length of labor (p = 0.0016), more use of oxytocin (p = 0.033), less back/pelvic pain (p = 0.0043 two sided t test), more headache (p = 0.015), less disturbed sleep (p = 0.085). No difference in analgesic/epidural use or episiotomy. Perinatal outcomes: No difference in newborn weight or Apgar score. |
15. | O’Cathain, 2002 | Autonomy | Intervention: 10 pairs of informed choice leaflets covering prenatal health and labor topics. Where: United Kingdom (Wales) Population: Pregnant women Study Design: Cluster trial, with maternity units randomized to intervention and control Sample size: 6452 | PCC: Increase in satisfaction with information (OR = 1.4), no difference in: women reporting that they exercised informed choice, active decision making, support of partner. Labor and delivery: No difference in planned place of birth, epidural use, in staying in bed during labor. Mental health: No difference in anxiety. |
16. | Sandall, 2015 | Autonomy | Systematic review and meta-analysis of Midwife-led continuity models versus other models of care. Fifteen randomized controlled trials included. Sample size: 17,674 | PCC (selected): Dignity (Midwife interested in me as a person, OR 7.50); Autonomy (multiple measures higher for satisfaction, decision making); Communication (asking questions t = 6.6; encouraged to ask question OR 4.22); Supportive care (midwives always friendly, OR 3.48); Trust (midwife skill t = 3.44). Labor and Delivery: Fewer epidurals (0.85, 95%CI 0.78 to 0.92), fewer instrumental vaginal delivery (RR 0.90, 95%CI 0.83 to 0.97), more spontaneous vaginal delivery (RR 1.05, 95%CI 1.03 to 1.07). No differences in caesarean section or intact perineum. Perinatal: Fewer preterm births (RR 0.76, 95%CI 0.64–0.91), fewer neonatal deaths (RR 0.84, 95%CI 0.71 to 0.99). |
Person-centered Objective: Supportive Care | ||||
17. | Consonni, 2010 | Supportive Care | Intervention: Ten prenatal meetings with these elements: educational (pregnancy knowledge), physiotherapeutic (breathing, kinesiotherapy, relaxation), interaction components (discussing pregnancy experiences, emotions), and relaxation (physical and mental). Where: Brazil Population: Nulliparous pregnant women Study design: Not randomized controlled trial, group selection based on participation Sample size: 67 | Labor and delivery: More vaginal birth (81% vs. 58.6%, p < 0.05 chi square test). Perinatal: No difference in preterm birth, birth weight or Apgar < 7 at 5 min. Mental health: Lower trace anxiety (p < 0.05 independent t-test). |
18. | El-Mohandes, 2011 | Supportive Care | Intervention: Integrated behavioral intervention based on social cognitive theory. Where: United States Population: High risk African-American pregnant women Study design: randomized controlled trial, intent-to-treat analysis Sample size: 819 | Perinatal: Fewer very preterm births (OR = 0.42, 95% CI = 0.19–0.93) (not significant for low birth weight (LBW) or preterm). Mental Health: No difference in depression scale. |
19. | Gagnon, 1999 | Supportive Care | Intervention: One-to-one nursing care, which consisted of emotional and physical support for women undergoing oxytocin labor augmentation. Where: United States Population: Pregnant women, singleton Study Design: Secondary analysis of a randomized controlled trial Sample size: 100 | Labor and delivery: No significant differences in cesarean delivery, epidural anesthesia, instrumental delivery, intact perineum, or mean duration of labor. Perinatal: No difference in Neonatal Intensive Care Unit (NICU) admission. |
20. | Grassley, 2012 | Supportive Care | Intervention: Four maternity care visits by Intrapartum nurses and professional labor support by attending to physical and emotional needs. Where: United States Population: Pregnant adolescents Study Design: Separate sample posttest quasi-experimental Sample size: 106 | PCC: Higher scores on the Mackey Childbirth Satisfaction Rating Scale (p = 0.02). Labor and Delivery: No difference in vaginal delivery. |
21. | Harris, 2012 | Supportive Care | Intervention: Interdisciplinary program to promote physiologic birth and encourage active involvement of women and their families in maternity care. Where: Canada Population: Low income pregnant women Study design: Retrospective chart review of intervention facility compared to women in non-intervention facilities Sample size: 1238 | Labor and Delivery: More likely to plan a VBAC (RR 3.22, 95%CI 2.25–4.62), to be delivered by a midwife (41.9% vs. 7.4%, p < 0.001), to have intermittent fetal auscultation (RR 1.41, 95%CI 1.31–1.53), to have a 3rd degree laceration ((RR 1.23, 95%CI 1.08–1.40). Less likely to have an epidural (RR 0.75, 95%CI 0.69–0.81), to undergo induction of labor (RR0.83, 95%CI 0.74–0.93), to undergo cesarean section (RR 0.76, 95%CI 0.68–0.84). No difference in assisted vaginal delivery. Perinatal: Higher gestational age at delivery (39.2 vs 38.8, p < 0.0001), birth weight (3395.3 vs. 3315.9, p < 0.0001). No difference in stillbirth, Apgar< 7 at 5 min, or NICU admission. |
22. | Hodnett, 2010 | Supportive Care | Systematic review of interventions that provided additional support for women believed to be at high risk of low birth weight. Seventeen trials included. Sample size: 15,288 | PCC: No difference in satisfaction. Labor and delivery: Reduction in caesarean section (RR 0.87, 95% CI 0.78 to 0.97) Perinatal outcomes: No effect on preterm birth, LBW, or stillbirth. Mental Health: No difference in postpartum depression. |
23. | Ip, 2009 | Supportive Care | Intervention: Enhanced women’s self-efficacy for childbirth and coping abilities for pain and anxiety through two 90-min educational sessions. Where: China Population: Primigravidae pregnant women Study Design: Randomized controlled trial Sample size: 133 | PCC: Higher levels of self-efficacy for childbirth (p < 0.0001), and greater performance of coping behavior during labor (p < 0.01). Labor and Delivery: Lower perceived anxiety (p < 0.001, early stage and p = 0.02, middle stage) and pain (p < 0.01, early stage and p = 0.01, middle stage). Mental Health: Lower perceived anxiety (p < 0.001, early stage and p = 0.02, middle stage). |
24. | Kildea, 2012 | Supportive Care | Intervention: A specialist antenatal clinic using participatory methods. Where: Australia Population: Indigenous (Aboriginal and Torres Strait Islander) Australian pregnant women Study Design: Women who attended specialist clinic compared to women in same facility and time period who did not Sample size: 800 | PCC: One-question for culturally responsive care “Felt most understood” at the specialty clinic (92%) vs. birth suite (47%). Labor and Delivery: Increased prenatal visits (p = 0.007), more spontaneous vaginal births (p = 0.06), more intact perineum (p < 0.001). No differences in analgesia, and postpartum bleeding. Perinatal outcomes: No differences in preterm birth, 5 min Apgar < 7, LBW, NICU admission. |
25. | Mason, 2011 | Supportive Care | Intervention: A case management program, to improve prenatal and post-partum care through enhanced member outreach and incentives, wellness materials, intensive case management, and provider incentives. Where: United States Population: Medicaid recipients Study Design: Retrospective propensity adjusted cohort comparison Sample size: 76735 | Perinatal outcomes: LBW less likely to have poor outcome (OR 0.921, 95%CI 0.869–0.975). |
26. | Newman, 2008 | Supportive Care | Intervention: Prevention of Preterm Birth (PTB) through case identification, risk assessment, 24 h perinatal hotline, high risk case management. Where: United States Population: Medicaid population with any of 9 predetermined historical or current pregnancy high-risk triggers Study Design: Pre/post design Sample size: 6356 | Perinatal outcomes: Reduction in PTB below 28 weeks (RR 0.75, 95%CI 0.5–0.96 p = 0.029), reduction in frequency (RR 0.86, 95%CI 0.75–0.98) p = 0.04) and mean duration of NICU admission (25.0 vs 20.6 days, p = 0.01). |
27. | Panaretto, 2005 | Supportive Care | Intervention: A collaborative prenatal care program for women based on common sense, continuity of care, cultural currency and a family-friendly environment, cultural safety aspects of the Aboriginal Medical Service and the collocation of mental health, dental and social support services. Where: Australia Population: Indigenous, urban women Study Design: Pre/Post evaluation Sample size: 1000 | Labor and Delivery: Increased number of prenatal visit (3 vs. 7, p < 0.001). Perinatal outcomes: Fewer preterm births (8.7% vs 14.3%, p < 0.01). No difference in LBW or perinatal mortality. |
28. | Rouhe, 2013 | Supportive Care | Intervention: Intervention for women with severe fear of childbirth with six sessions of psycho-educative group therapy led by a continuity psychologist, including a guided relaxation exercise. Where: Finland Population: nulliparous women with fear of childbirth Study design: randomized controlled trial Sample size: 400 | PCC: Higher positive delivery experience > 75 centile on delivery satisfaction scale (DSS) scale (36.1 vs. 22.8%, p = 0.04), and lower Wijma Delivery Experience Questionnaire (W-DEQ-B) scores 63.0 vs. 73.7, p = 0.02). Labor and delivery: More spontaneous vaginal births (63% vs. 47% p = 0.005) and fewer caesarean section (22.9% vs. 32.5%, p = 0.05). No difference in epidural, induction of labor, length of labor. Perinatal outcomes: No difference in birth weight, cord artery pH < 7.1, 1 min Apgar < 7. |
29. | Ryding, 2003 | Supportive Care | Intervention: Consultation with specially trained midwives, including discussion about past traumatic experiences (birth or childhood) and to development of a birth plan. Where: Sweden Population: Women with fear of childbirth Study Design: Women who consulted midwives for fear of childbirth and got intervention matched to women in same facility who did not receive intervention Sample size: 112 | PCC: Higher negative/frightening experience (W-DEQ mean difference 14.6, p = 0.0001). Labor and delivery: More vaginal delivery (44.7% vs 27.5%). Mental health: Higher Impact of Event Scale (IES) score > 30 indicating possible Post-Traumatic Stress Disorder (PTSD) (19% vs 2%, OR 12.1, 95%CI 2.2–66.6). |
30. | Saisto, 2001 | Supportive Care | Intervention: Intensive therapy group for fear of childbirth, including discussion of obstetric experiences, feelings, misconceptions. The therapy was integrated into routine antenatal care and combined with cognitive exercises. Where: Finland Population: Pregnant women with fear of childbirth Study Design: A Randomized Controlled Trial Sample size: 176 | PCC: Decrease in birth related concerns (p = 0.022). No difference in satisfaction with childbirth or in puerperal depression. More intervention women remembered, “not feeling safe” (p = 0.02). Labor and delivery: Fewer maternal request cesareans (36% vs 41% of original request, p > 0.05) and shorter labor (6.8 h vs 8.5 h, p = 0.039) Mental health: Decrease in pregnancy-related anxiety (p = 0.054). No difference in depression. |
31. | Vieten, 2008 | Supportive Care | Intervention: A Mindful Motherhood intervention including general mindfulness strategies such as awareness of thoughts and feelings, guided body awareness and yoga, and acceptance of self. This also included awareness of the developing fetus, mindfulness around pregnancy/labor pain and parenting, and prenatal yoga. Where: United States Population: Pregnant women with “mood concerns” Study design: randomized trial Sample size: 21 | Mental Health: Greater % improvement at 8 weeks post intervention for anxiety, depression, perceived stress, positive affect, negative affect, mindfulness, and affect regulation. However, these changes were diminished at 3-month follow up. |
Person-Centered Objective: Social support | ||||
32. | Barr, 2011 | Social Support | Intervention: Group prenatal care model implemented into a family practice residency program. Where: United States Population: Pregnant women Study Design: Pre- and post-intervention design Sample size: 400 | Labor and Delivery: Lower odds of cesarean (OR 0.61, 95%CI 0.37–1.01). Perinatal outcomes: Lower LBW (OR 0.43, 95%CI 0.18–1.06) and preterm birth (OR 0.39, 95%CI 0.15–0.98). |
33. | Bloom, 2005 | Social Support | Intervention: Group antenatal care (ANC) provided by midwives for adolescents in a public school setting Where: United States Population: Pregnant Adolescents Study Design: Intervention compared to adolescents receiving standard ANC care Sample size: 120 | PCC: Improvement in knowledge (100% Group ANC vs. 55% control, p < 0.05). No significant differences with self-esteem or health locus of control. Perinatal: No significant difference in preterm births. |
34. | Catling, 2015 | Social Support | Systematic review and meta-analysis of group vs. conventional ANC. Four group antenatal care randomized controlled trails. Sample size: 2350 | PCC: marginally higher satisfaction (mean diff 4.90, 95%CI 3.10–6.70, p < 0.001). No differences in perceived stress. Labor and delivery: No significant differences in induction/augmentation of labor, epidural use, episiotomy, or spontaneous vaginal birth. Perinatal: No significant differences in preterm birth, LBW, SGA, perinatal mortality. Mental health: No differences in depression. |
35. | Gruber, 2013 | Social Support | Intervention: women were given the option of a having a doula or not. Where: United States Population: Socially disadvantaged pregnant women Study design: Non-experimental design with assignment to groups (doula vs. non-doula) based on self selection Sample size: 226 | Labor and delivery: No difference in vaginal delivery or maternal complications. Perinatal outcomes: Fewer lower birth weight babies (z score = 1.78, p = .04). |
36. | Gungor, 2007 | Social Support | Intervention: Fathers allowed in labor room, oriented to delivery room and birth process, allowed to be present in delivery. Where: Turkey Population: Primigravidae low-risk pregnant women who wanted their partner to be present Study Design: First half of eligible women received intervention compared to the second half of eligible women Sample size: 50 | PCC: More positive view of delivery process, labor process, partner participation, awareness and delivery outcome (p < 0.05 for all). Labor and delivery: no difference in pain medication, use of obstetric interventions, or labor length. |
37. | Hodnett, 2013 | Social Support | Systematic Review of interventions on continuous support compared to standard care. Twenty-two studies included. Sample size: 12,264 | PCC: Less likely to report dissatisfaction (RR 0.69, 95% CI 0.59–0.79). Labor and delivery: More spontaneous vaginal birth (RR 1.08, 95%CI 1.04–1.12), less intrapartum analgesia (RR 0.90, 95% CI 0.84–0.96) and regional analgesia (RR 0.93, 95% CI 0.88–0.99), shorter labors (MD −0.58 h, 95% CI -0.85 - 0.31), less likely to have a caesarean (RR 0.78, 95% CI 0.67–0.91) or instrumental vaginal birth (fixed-effect, RR 0.90, 95% CI 0.85–0.96). No difference on maternal complications. Perinatal outcomes: Lower risk of baby with low five-minute Apgar score (fixed-effect, RR 0.69, 95% CI 0.50–0.95). No difference on neonatal complications. |
38. | Kunene, 2004 | Social Support | Intervention: Providing training to health providers on couple counseling, invited partners of antenatal women to attend counseling twice during pregnancy and once post-delivery, and provided information to couples. Where: South Africa Population: Pregnant women and partners Study Design: Cluster randomized controlled trial Sample size: 2082 | PCC: Partner more likely to assist during pregnancy emergencies (p = 0.004). |
39. | Mullany, 2007 | Social Support | Intervention: Husband present for pregnancy health education visits, consisting of two 35-min sessions based on the principals of reasoned action and the health belief model. Where: Nepal Population: Pregnant women Study Design: Randomization Sample size: 442 | PCC: More likely to make > 3 birth preparations (RR 1.99, 95%CI 1.10–3.59). Labor and Delivery: No difference in attending prenatal visits, delivering in an institution, or having a skilled provider at birth. |
Person-centered Objective: The care environment | ||||
40. | Hodnett, 2012 | The Care Environment | Systematic review and meta-analysis of alternative institutional birth settings. Ten studies included. Sample size: 11,795 | PCC: Increased “very positive” views of care (RR 1.96, 95%CI 1.78–2.15). Labor and Delivery: Decreased epidural anesthesia (RR 0.8, 95%CI 0.74–0.87), decreased oxytocin augmentation 0.77, 95%CI 0.67–0.88), increased vaginal birth (RR 1.03, 95%CI 1.02–1.06), decreased episiotomy (RR 0.83, 95%CI 0.77–0.90). Perinatal: No difference in admission to NICU, Apgar score and perinatal death. |
41. | Janssen, 2001 | The Care Environment | Intervention: Single room maternity unit where intrapartum and postpartum care are given in the same room with continuity of nursing care through labor, birth, and postpartum Where: Canada Population: Low-risk pregnant women Study Design: Intervention group compared to women historical control group Sample size: 430 | PCC: More time with support people (p = 0.005), more time spent with newborn in room (p = 0.007), more privacy (p < 0.001), less noise (p < 0.001), more support from nurses (p < 0.001), Higher ratings for natural childbirth, making informed choices, having choices supported (p < 0.001). Increase in perceived knowledge (p < 0.001). Labor and Delivery: More comfort measures for pain in labor and postpartum pain (p < 0.001). |
Person-centered Objective: Dignity | ||||
42. | Abuya, 2015 | Dignity | Intervention: Multilevel intervention aimed to address disrespect and abuse in childbirth, included engaging policymakers, training providers on respectful maternity care, and strengthening linkages between the facility and community for accountability and governance Where: Kenya Population: Postpartum women Study Design: Pre/post Sample size: 1369 | PCC: Disrespect and abuse decreased from 20 to 13% (p < 0.004), some forms of disrespect and abuse decreased from 40 to 50%. Inappropriate detainment of women and infant in the facility declined from 8.0–0.8%. No difference in privacy violation and a small improvement confidentiality violation. No difference in abonnement. |